Council Wants to Strengthen Supports for Medically Uninsured Residents

Toronto city council wants to improve health care for medically uninsured residents, especially those who avoid treatment because they lack immigration status in Canada. They can’t do it all directly, but on Thursday night, councillors voted 21-7 to ask the provincial government to strengthen access to basic health care programs for residents ineligible for the Ontario Health Insurance Plan (OHIP).
Many refugees, undocumented residents, people who have lost their identification, and even permanent residents of Canada do not qualify for OHIP benefits. Dr. David McKeown, Toronto’s Medical Officer of Health, says that expanding health care access is both humanitarian and practical. “Early intervention is almost always less costly than dealing with a more advanced illness later in its course,” he told council.

According to a Board of Health report on the medically uninsured [PDF], the most vulnerable of them are undocumented residents, many of whom avoid hospitals for fear of deportation. When these individuals do access emergency medical services, they are routinely billed several times more for services than insured residents. That too needs attention, say some. “The billing system needs an overhaul so that anyone can access health care at a fair price,” maintained Denise Gastaldo, associate professor at the Lawrence S. Bloomberg Faculty of Nursing, after council’s vote. “Today’s decision is a step in the right direction.”

Also among those who can’t access services: permanent residents, who are eligible for OHIP benefits, but only after a three month waiting period. Council has asked the province to eliminate this gap in service, citing the fact that permanent residents spend years going through the application process before being accepted, and that by the time they arrive here they have already met immigration requirements.

McKeown also attempted to dispel myths about so-called “medical tourists,” who migrate to Ontario simply to receive medical care. “That’s not in fact what happens most of the time,” he said.

A few councillors remained unconvinced, arguing that medical tourists are indeed taking advantage of health care services in Ontario. “You can land at Pearson, and come into Toronto and say ‘I’m here, give me services,’ ” said councillor David Shiner (Ward 24, Willowdale). Councillor Mike Del Grande (Ward 39, Scarborough-Agincourt) said that he’s heard criticism of the proposal from older, “bonafide” immigrants. “Now all of a sudden, there’s a different kind of attitude with new immigration that you meet them at the door and have to provide everything,” Del Grande said.

Councillor John Filion (Ward 23 Willowdale) questioned the sincerity of such arguments. “If [Del Grande] saw an injured child, he wouldn’t say, ‘show me your citizenship,’ ” Filion argued. “It’s very easy to push your no button when it’s a bunch of faceless people you don’t meet.” Filion and others also argued that uninsured people with communicable illnesses threaten public health if they refrain from seeking treatment.

The province already funds services for the medically uninsured, mainly through local community health centres. Yesterday’s recommendations include requests to increase funding for those services. Council has also asked the federal government to restore cuts to critical refugee health care funding, made last summer.

Axelle Janczur, executive director of community health care hub Access Alliance, said that while some health care solutions for the uninsured involve navigating complex immigration circumstances, many are easy to solve. “We need to know who exactly has access, and provide them with better information,” Janczur said. “That part is not really controversial.”